6 Years After Obamacare’s Passage, Haters Refuse to Accept Reality

Opponent of Obamacare who is probably not going to be swayed by data indicating the program has succeeded.
Photo: Bill Clark/CQ Roll Call

During the Obama era, the keenest minds in the conservative movement have had to develop policy responses to the administration’s agenda. But those policies had to be crafted within bounds established by Republican politics — conservative ideas were useful only insofar as conservative politicians could plausibly advocate them. Republican politicians, in turn, had to operate within the bounds of what their voters considered acceptable. And Republican voters, as the 2016 election cycle has made abundantly clear to even those long committed to denying it, are bat-shitcrazy.

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That frothing quality burst forth in its fullest form during the debate over health-care reform, in the summer of 2009. Angry Republicans flooded town hall meetings to denounce a law that they saw as redistributing resources from people like themselves to people who were not, identifying sources of grievance both real (cuts to Medicare) and imagined (death panels). The Republican Party’s stance on health-care reform took shape during those days of rage, and even six years after the law’s passage, its position on Obamacare has remained unaltered. The law is a failure and must be repealed, and no evidence can convince conservatives otherwise. A half-dozen years after its passage, none have dared revise that stance.

One of Obamacare’s goals, beyond expanding access to health insurance and paying for its budgetary costs, was to “bend the curve” of health-care inflation, which has historically grown faster than the cost of other things. The law implemented a wide array of reforms designed to bring more cost-consciousness into the system. Indeed, health-care inflation has not only slowed, it has dropped to the lowest level since the government began measuringit:

Some aspects of the lower health-care-inflation rate can be clearly tied to Obamacare reforms. For instance, the old Medicare system gave hospitals little incentive to keep their patients healthy once admitted. Just the opposite: A patient who acquired an illness in the hospital, or had to be readmitted, would receive more treatment, making more money for the hospital. Obamacare changed its reimbursements to penalize hospitals with high readmission rates. And sure enough, medical errors in hospitals are down, as are patient readmission rates:

Other reforms have worked through the medical economy in ways that are harder to measure as precisely. It’s impossible to know just what proportion of credit the law deserves for the lower inflation rate, some of which might have occurred anyway. (Or it might not — it can’t beproven.)

Among conservatives, though, it remains an unchallengeable certainty that Obamacare has failed. What about the historically low medical inflation? Ramesh Ponnuru, a leading conservative intellectual, expresses his certainty that the entire trend would have happened without any of the law’s cost reforms. According to Ponnuru, health-care inflation was already falling before Obamacare’senactment:

The administration argues that the law has contributed to a slowdown in the growth of health spending. But that slowdown started in 2002. Obamacare can’t be the cause. The best that can be said about the law’s effect on health spending is that its early years haven’t interrupted thatslowdown.

This data point is the state of the art in gainsaying Obamacare’s success. Here is what Ponnuru is referring to. During the middle of the last decade, health-care inflation had a mini-spike, which had already begun to recede by the time Obamacare was signed into law. But this doesn’t mean that health-care inflation was on an inexorably falling trajectory. It simply means that the unusually elevated levels of health-care inflation that took place during the Bush administration’s second term had given way to historically normal health-care inflation rates that were still unsustainably high. What has occurred since 2010 is not more of the same. It is a rate of health-care inflation farlower:

I followed the health-care debate extremely closely. In 2010, I was not aware of any influential analysts who predicted that health-care inflation was poised to drop to historically low rates on its own. Not only was that view unheard-of at the time, there was a deep skepticism that Obamacare could do much if anything to ameliorate it. Indeed, conservatives were unanimous in their belief that Obamacare would not only fail to bring down health-care inflation, it would cause health-care inflation to skyrocket. Ponnuru predicted that Obamacare would “exacerbate” health-careinflation:

The trouble is that the cost explosion is in the first place largely a function of the way the government has used its power as a provider and regulator of health insurance. The open-ended structure of Medicare and of the employer-based-insurance tax exclusion, together with the way Medicaid costs are shared by states and the federal government, have created huge incentives to spend more on health care, and therefore pushed costs upward. Obamacare would double down on an approach to limiting Medicare costs that has failed for decades, would massively expand Medicaid without reforming it, and would largely keep in place the tax exclusion while adding a new entitlement on top of it. It would exacerbate the causes of the cost problem while moving us further away from a real market in healthinsurance.

This was a testable hypothesis. If health-care costs rose at a higher rate than they had before 2010, conservative critics of the law would have reason to claim vindication. Indeed, they seized on every preliminary scrap of data that seemed to indicate higher health-care costs. National Review (where Ponnuru works as a senior editor) editorialized, beginning in 2010, that Obamacare was already causing health-care inflation torise:

Health-insurance rates already are rising even more quickly than they had been in the past because of concern about the costs that will be imposed by Obamacare … These consequences were unintended, but they were not unpredictable: They were, in fact, predicted by a very large number of critics, not least those writing for National Review.

Conservatives have gone from absolute ideological certainty that health-care inflation would rise in the wake of Obamacare to absolute ideological certainty that the drop in health-care inflation has nothing at all to do with Obamacare. It’s obvious that no conceivable data can falsify conservative opposition to Obamacare. The premise that Obamacare has failed is a matter of doctrinal writ, as holy as the sanctity of the great Ronald Reagan. To abandon this position is to abandon conservatism itself. Conservatives can try to redirect their base’s rage toward the construction of an alternative plan to replace Obamacare, but they cannot concede that the law has actually succeeded in advancing its stated goals. Republicans hate Obamacare not for its concrete outcomes but for what it represents to them. If Trump’s campaign has demonstrated anything, it is the hopelessness of crafting technocratic justifications for the pulsating right-wingId.

Jared Kushner, the president’s son-in-law and senior adviser, uses an unofficial online messaging service for official White House business, including with foreign contacts, his lawyer told the House Oversight Committee late last year.

The lawyer, Abbe Lowell, said he was not aware if Mr. Kushner had communicated classified information on the service, WhatsApp, and said that because he took screenshots of the communications and sent them to his official White House account or the National Security Council, his client was not in violation of federal records laws.

In a letter disclosing the information, the Democratic chairman of the House Oversight and Reform Committee said that he was investigating possible violations of the Presidential Records Act by members of the Trump administration, including Mr. Kushner and his wife, Ivanka Trump. He accused the White House of stonewalling his committee on information it had requested for months.

Sen. Joni Ernst (R-Iowa) on Thursday urged President Donald Trump to stop disparaging the late Sen. John McCain, calling the Vietnam war hero “a dear friend” and defending him against the president’s criticisms. …

Ernst’s remarks came during a town hall meeting at a high school in Adel, Iowa, where several attendees voiced anger about Trump’s attacks about McCain. One attendee described McCain as a “genuine war hero” and called Trump’s comments about McCain “cowardly.”

“I do not appreciate his tweets,” Ernst said, when pressed by the attendee why she didn’t previously speak out more forcefully. “John McCain is a dear friend of mine. So, no I don’t agree with President Trump and he does need to stop.”

As we anticipate the end of Mueller, signs of a wind-down:-SCO prosecutors bringing family into the office for visits-Staff carrying out boxes-Manafort sentenced, top prosecutor leaving-office of 16 attys down to 10-DC US Atty stepping up in cases-grand jury not seen in 2mo

For Boeing and other aircraft manufacturers, the practice of charging to upgrade a standard plane can be lucrative. Top airlines around the world must pay handsomely to have the jets they order fitted with customized add-ons.

Sometimes these optional features involve aesthetics or comfort, like premium seating, fancy lighting or extra bathrooms. But other features involve communication, navigation or safety systems, and are more fundamental to the plane’s operations.

Many airlines, especially low-cost carriers like Indonesia’s Lion Air, have opted not to buy them — and regulators don’t require them. Now, in the wake of the two deadly crashes involving the same jet model, Boeing will make one of those safety features standard as part of a fix to get the planes in the air again.

… Boeing’s optional safety features, in part, could have helped the pilots detect any erroneous readings. One of the optional upgrades, the angle of attack indicator, displays the readings of the two sensors. The other, called a disagree light, is activated if those sensors are at odds with one another.

Boeing will soon update the MCAS software, and will also make the disagree light standard on all new 737 Max planes, according to a person familiar with the changes, who spoke on condition of anonymity because they have not been made public. The angle of attack indicator will remain an option that airlines can buy.

Attorneys for New England Patriots owner Robert Kraft and more than a dozen other defendants charged in a Florida prostitution sting filed a motion to stop the public release of surveillance videos and other evidence taken by police.

Attorneys filed the motion Wednesday in Palm Beach County court. The State of Florida does not agree with the request, according to the filing.

In the motion, the attorneys asked the court to grant a protective order to safeguard the confidentiality of the materials seized from the Orchids of Asia Day Spa in Jupiter, and “in particular the videos, until further order of the court.”

Two years in, White House aides are dismayed to discover the president likes lobbing pointless, nasty attacks at people like George Conway and John McCain

But the saga has left even White House aides accustomed to a president who bucks convention feeling uncomfortable. While the controversies may have pushed aside some bad news, they also trampled on Trump’s Wednesday visit to an army tank manufacturing plant in swing state Ohio.

“For the most part, most people internally don’t want to touch this with a 10-foot pole,” said one former senior White House official. A current senior White House official said White House aides are making an effort “not to discuss it in polite company.” Another current White House official bemoaned the tawdry distraction. “It does not appear to be a great use of our time to talk about George Conway or dead John McCain. … Why are we doing this?

When Mr. Trump was running for president, he promised to personally stop American companies from shutting down factories and moving plants abroad, warning that he would punish them with public backlash and higher taxes. Many companies scrambled to respond to his Twitter attacks, announcing jobs and investments in the United States — several of which never materialized.

But despite Mr. Trump’s efforts to compel companies to build and hire, they appear to be increasingly prioritizing their balance sheets over political backlash.

“I don’t think there’s as much fear,” said Gene Grabowski, who specializes in crisis communications for the public relations firm Kglobal. “At first it was a shock to the system, but now we’ve all adjusted. We take it in stride, and I think that’s what the business community is doing.”

There’s no specific stipulation that Milo must be heard, so it could be worse

President Trump is expected to issue an executive order Thursday directing federal agencies to tie research and education grants made to colleges and universities to more aggressive enforcement of the First Amendment, according to a draft of the order viewed by The Wall Street Journal.

The order instructs agencies including the Departments of Education, Health and Human Services and Defense to ensure that public educational institutions comply with the First Amendment, and that private institutions live up to their own stated free-speech standards.

The order falls short of what some university officials feared would be more sweeping or specific measures; it doesn’t prescribe any specific penalty that would result in schools losing research or other education grants as a result of specific policies.

Tech companies say that it is easier to identify content related to known foreign terrorist organizations such as ISIS and Al Qaeda because of information-sharing with law enforcement and industry-wide efforts, such as the Global Internet Forum to Counter Terrorism, a group formed by YouTube, Facebook, Microsoft, and Twitter in 2017.

On Monday, for example, YouTube said on its Twitter account that it was harder for the company to stop the video of the shootings in Christchurch than to remove copyrighted content or ISIS-related content because YouTube’s tools for content moderation rely on “reference files to work effectively.” Movie studios and record labels provide reference files in advance and, “many violent extremist groups, like ISIS, use common footage and imagery,” YouTube wrote.

The cycle is self-reinforcing: The companies collect more data on what ISIS content looks like based on law enforcement’s myopic and under-inclusive views, and then this skewed data is fed to surveillance systems, Bloch-Wehba says. Meanwhile, consumers don’t have enough visibility in the process to know whether these tools are proportionate to the threat, whether they filter too much content, or whether they discriminate against certain groups, she says.

Two mystery litigants citing privacy concerns are making a last-ditch bid to keep secret some details in a lawsuit stemming from wealthy financier Jeffrey Epstein’s history of paying underage girls for sex.

Just prior to a court-imposed deadline Tuesday, two anonymous individuals surfaced to object to the unsealing of a key lower-court ruling in the case, as well as various submissions by the parties.

Both people filed their complaints in the New York-based 2nd Circuit Court of Appeals, which is overseeing the case. The two people said they could face unwarranted speculation and embarrassment if the court makes public records from the suit, in which Virginia Giuffre, an alleged Epstein victim, accused longtime Epstein friend Ghislaine Maxwell of engaging in sex trafficking by facilitating his sexual encounters with teenage girls. Maxwell has denied the charges.